前列腺特异抗原水平为4～10 μg/L的前列腺癌诊断对策

目的评价现有的前列腺特异抗原(PSA)修正方法对PSA在4~10μg/L的前列腺癌的诊断价值。方法选取经直肠B超引导下前列腺多点穿刺活检血PSA测值在4~10μg/L的86例患者,分析其PSAD、PSATZ、F/T比值及PSA修正方法各域值范围内,对前列腺癌诊断的敏感度及特异度。结果PSAD、PSATZ和F/T比值在各域值范围内,对诊断前列腺癌的敏感度均未超过50%,将PSAD域值设为0.18μg/L/cc时有较高的敏感度,F/T比值设为0.25时有较高的特异度,而PSATZ在各域值范围内对前列腺癌的敏感度及特异度无显著优势。结论PSA修正方法不能有效提高国人血PSA4~10μg/L的前列腺癌检出率;当PSAD超过0.18μg/L应建议患者作前列腺穿刺活检,F/T比值小于0.25则应增加穿刺点。

The strategy to enhance predictive value of serum prostate specific antigen between 4 to 10 μg/L

Objective:To investigate the value of current prostate specific antigen based parameters, and trying to find the way for the detection of prostate cancer in patients with serum prostate specific antigen levels between 4 to 10 ng/ml.Methods:From 2002.9 to 2004.2,86 intermediated PSA cases undergo ultrasound guided prostate biopsy in our hospital, and 17 patients are prostate cancer. We analysis the PSAD, PSATZ and Free/Total PSA ratio of these patients, and the sensitivity and specialty of these PSA parameters at different thresholds to diagnose prostate cancer of these cases.Results:None of the sensitivity of these current used PSA based parameters is more than 50%. It has the highest sensitivity when the threshold of PSAD is 0.18 ng/ml/cc, and selecting threshold of F/T ratio 0.25 can get the highest specialty.Conclusions:Current PSA parameters can not enhance the value of PSA for detecting prostate cancer of Chinese patients with intermediate PSA level. In response, patients should undergo ultrasound guided prostate biopsy if PSAD exceed 0.18 ng/ml/cc, and it is necessary to take additional cores besides the standard sextant prostate biopsy if F/T ratio is lower than 0.25 .